Interpersonal Continuity of Care May Help Delay Progression to Type 2 Diabetes.

Background: The association between interpersonal continuity of care (CoC) and progression from the prediabetic state to Type 2 Diabetes (T2D) remains unknown.

Aim: To evaluate the association between interpersonal CoC and the progression to T2D among persons with prediabetes.

Design And Setting: A retrospective cohort study using electronic health record (EHR) data from 6620 patients at Geisinger, a large rural health care system in Danville, PA.

Association of rurality and decreased continuity of care prior to a diagnosis of prediabetes.

Purpose: To assess trends in continuity of care (COC) by geographic context (i.e., rural vs urban) among a cohort of persons with prediabetes prior to and after diagnosis of prediabetes.

Biliopancreatic diversion with duodenal switch results in superior weight loss and diabetes remission in patients with baseline body mass index ≥50.

Background: Patients with body mass index (BMI) ≥50 have more obesity-associated medical problems and often require more aggressive surgical management. Few single-institution comparative studies have been published examining this specific population.

Objectives: The study aims to compare the weight loss and diabetes remission effects of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch (BPD/DS).

Comparing models that integrate obstetric care and WIC on improved program enrollment during pregnancy: a protocol for a randomized controlled trial.

Background: Low-income, rural pregnant women are at disproportionate risk for adverse pregnancy outcomes as well as future cardiovascular risk. Currently, less than half of eligible women enroll in the Women, Infants, and Children's (WIC) Program. This study aims to evaluate whether integrating clinical care and social care may advance health equity and reduce health disparities by directly linking women receiving obstetric care to the Special Supplemental Nutrition Program for WIC and/or a Registered Dietitian/Nutritionist (RDN).

Robotics, money and research: is data or physician payments driving robotic bariatric surgery literature?

Introduction: Physician payments from Intuitive Surgical have increased from 37 million to over 53 million per year since 2018. The study was completed to determine the accuracy of conflict of interest (COI) statements and the influence of industry payments on the valuation of the robotic platform.

Methods: PubMed and Medline search for "robotic, robotic assisted" and "bariatric, Gastric Bypass, Sleeve Gastrectomy, Biliopancreatic Diversion, and Single Anastomosis Duodeno-Ileal Bypass".

Long-term incidence of bariatric related procedures following laparoscopic gastric bypass: 15 to 20 years single institution experience.

Background: Long-term data on the likelihood of undergoing additional related operations after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remain scarce.

Objectives: The aims of this study are to identify the long-term incidence of bariatric related operations, patient's predictive factors, and most common operations in the 15-20 years following LRYGB.

Setting: Single Academic Institution, Center of Bariatric Excellence.

Iron Treatment in Patients with Iron Deficiency Before and After Metabolic and Bariatric Surgery: A Narrative Review.

Iron is an essential nutrient in living organisms with multiple vital functions. Iron deficiency (ID) can cause long term health consequences beyond iron deficiency anemia (IDA). The high prevalence of ID and its long-term effects in patients with obesity and after metabolic and bariatric surgery (MBS) is recognized.

Iron homeostasis in obesity and metabolic and bariatric surgery: a narrative review.

Iron deficiency has been recognized as a potentially modifiable nutritional complication of metabolic and bariatric surgery (MBS) since prior to the turn of the century. Despite this, it remains the most common and clinically significant nutritional complication of this surgery with the potential to negate quality of life and the health benefits of surgical weight loss. This narrative review summarizes the current literature regarding iron deficiency as it relates to patients with severe obesity and those who undergo MBS.

Home environment factors associated with child BMI changes during COVID-19 pandemic.

Background: The influence of home obesogenic environments, as assessed by the validated Family Nutrition and Physical Activity (FNPA) tool, and child obesity during the COVID pandemic were evaluated using electronic health records in this retrospective cohort study.

Methods: Historical data on BMI and the FNPA screening tool were obtained from annual well-child visits within the Geisinger Health System. The study examined youth ages 2-17 that had a BMI record and an FNPA assessment prior to the pandemic (BMI 3/1/19-2/29/20), 1 BMI record 3 months into the pandemic (6/1/20-12/31/20) and 1 BMI in the second year of the pandemic (1/1/21-12/31/21).

Effects of glucagon-like peptide-1 receptor agonists on upper endoscopy in diabetic and nondiabetic patients.

Background And Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) promote weight loss by suppressing appetite, enhancing satiety, regulating glucose metabolism, and delaying gastric motility. We sought to determine whether GLP-1 RA use could affect medical procedures such as EGD.

Methods: We conducted a retrospective study of 35,183 patients who underwent EGD between 2019 and 2023, 922 of whom were using a GLP-1 RAs.

Agreement between parent-report and EMR height, weight, and BMI among rural children.

Introduction: Remote anthropometric surveillance has emerged as a strategy to accommodate lapses in growth monitoring for pediatricians during coronavirus disease 2019 (COVID-19). The purpose of this investigation was to validate parent-reported anthropometry and inform acceptable remote measurement practices among rural, preschool-aged children.

Methods: Parent-reported height, weight, body mass index (BMI), BMI z-score, and BMI percentile for their child were collected through surveys with the assessment of their source of home measure.

Childhood Obesity and Early Body Mass Index Gains Associated with COVID-19 in a Large Rural Health System.

Objective: To evaluate body mass index (BMI) change among a population of children with a high proportion residing in rural areas across two pandemic time periods.

Methods: Electronic health records were evaluated in a rural health system.

Inclusion Criteria: 2-17 years at initial BMI; >2 BMIs during pre-pandemic (January 1, 2018-February 29, 2020); >1 BMI in early pandemic (June 1, 2020-December 31, 2020); and >1 BMI in later pandemic (January 1, 2021-December 31, 2021).

Laparoscopic sleeve gastrectomy conversion to gastric bypass: conversion rate over time, predictors of conversion, and weight loss outcomes.

Background: Laparoscopic sleeve gastrectomy (LSG) is the most common Bariatric procedure in the United States; however, the frequency of conversion to Roux-en-Y gastric bypass (RYGB) is unknown.

Objectives: The primary aim was to determine the conversion rate over time from LSG to RYGB. The secondary objectives were to evaluate factors associated with conversion and postconversion weight loss outcomes.

Clinical significance of iron deficiency among candidates for metabolic surgery.

Background: Iron deficiency (ID), a known complication after metabolic surgery, is common among preoperative patients in the presence of inflammation. Evidence is now accumulating that preoperative ID may adversely affect perioperative outcomes.

Objectives: To investigate the relationship between preoperative iron status and the risk of postoperative severe anemia.

Rates of Recurrent Marginal Ulcer in Gastric Bypass Patients Undergoing Revisional Surgery.

Introduction: The rate of marginal ulcer (MU) following primary Roux-en-Y Gastric Bypass (RYGB) is approximately .6-16%. Few studies have evaluated recurrence rates following surgical revision for MU.

Prior metabolic surgery reduced COVID-19 severity: Systematic analysis from year one of the COVID-19 pandemic.

Background: Obesity is a risk factor for COVID-19 severity. Recent studies suggest that prior metabolic surgery (MS) modifies the risk of COVID-19 severity.

Methods: COVID-19 outcomes were compared between patients with MS (n = 287) and a matched cohort of unoperated patients (n = 861).

Prospective Study of Diet Quality and the Risk of Dementia in the Oldest Old.

This study examined the associations between overall diet quality and the risk of dementia in a rural cohort among the oldest old. Included in this prospective cohort study were 2232 participants aged ≥ 80 years and dementia-free at the baseline according to the Geisinger Rural Aging Study (GRAS), a longitudinal cohort in rural Pennsylvania. In 2009, diet quality was assessed by a validated dietary screening tool (DST).

Bariatric revisional surgery for gastrogastric fistula following Roux-en-Y gastric bypass positively impacts weight loss.

Background: Gastrogastric fistula (GGF) is a rare complication from Roux-en-Y gastric bypass (RYGB). It is a known risk factor associated with weight recidivism and an indication for Bariatric Revisional Surgery (BRS).

Objectives: The primary outcome of this study is to evaluate perioperative outcomes and the long-term total body weight loss (TBWL) outcomes following revision.

Patient-reported outcome measures can advance population health, but is access to instruments and use equitable?

Patient reported outcome measures (PROM) can engage patients and clinicians to improve health outcomes. Their population health impact may be limited by systematic barriers inhibiting access to completion. In this analysis we evaluated the association between individual parent/child characteristics and clinic factors with parental completion of a locally developed PROM, the Early Healthy Lifestyles (EHL) questionnaire.

Stratified Preoperative A1c is not Significantly Associated With Clavien-Dindo Major Complications Following Bariatric Surgery in the MBSAQIP Database.

Background: Type 2 Diabetes Mellitus (T2DM) is highly prevalent comorbidity in patients with morbid obesity. It is still unclear whether a cutoff value of preoperative A1c represents an increased risk for major postoperative complications following Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG).

Methods: Retrospective MBSAQIP Participant Use File cohort for both years 2017 and 2018 were analyzed to evaluate the relationship between HbA1c in patients with morbid obesity and T2DM undergoing bariatric surgery, and the 30 days postoperative major complications by Clavien-Dindo classification (III/IV).

Family-Based Telehealth Initiative to Improve Nutrition and Physical Activity for Children With Obesity and Its Utility During COVID-19: A Mixed Methods Evaluation.

Guidelines recommend primary care providers refer children with obesity to behavioral interventions, but given limited program availability, access, and parental engagement, referrals remain rare. We developed telehealth coaching interventions for families whose children received care at a health system in Pennsylvania, United States in 2019-2020. Intervention referrals were facilitated by the pediatrician and/or project team for 6-12-year-old children with obesity following well-child visits.

Trauma pain management in the emergency department: use of methoxyflurane as a patient-administered analgesic.

Evidence suggests that pain is highly prevalent among patients with traumatic injuries who attend emergency departments (EDs), yet accurate assessment and management of patients with acute pain can be challenging in this setting. Effective and rapid pain management is beneficial for patients and can support timely discharge from the ED, which is particularly important in the context of the coronavirus disease 2019 (COVID-19) pandemic. This article describes a service development project that introduced the use of a patient-administered analgesic, methoxyflurane, for patients with traumatic injuries with moderate to severe pain in one ED.